The human plasma protein  2 -glycoprotein I ( 2 -GPI) is the most common target for antiphospholipid antibodies associated with thrombotic events in chronic disorders related to endothelial cell dysfunction. Crucial information is needed to clarify why this self-abundant protein is targeted by autoimmune responses. In this study, we investigated whether oxidative modification of  2 -GPI, either spontaneous in culture wells or induced by treatment with H 2 O 2 , renders this selfprotein able to activate immature monocyte-derived dendritic cells (DCs) from healthy human donors. Oxidized  2 -GPI caused DCs to mature so that CD83 appeared and CD80, CD86, human leukocyte antigen-D region related (HLA-DR), and CD40 increased. The interaction between oxidized  2 -GPI and DCs specifically stimulated these cells to secrete interleukin 12 (IL-12), IL-1, IL-6, IL-8, tumor necrosis factor ␣ (TNF-␣), and IL-10. Oxidized  2 -GPI-stimulated DCs had increased allostimulatory ability and primed naive T lymphocytes, thus inducing T helper 1 (Th1) polarization. The interaction between oxidized  2 -GPI and DCs involved interleukin-1 receptor associated kinase (IRAK) phosphorylation and nuclear factor B (NFB) activation. Pretreatment of  2 -GPI with the antioxidant ␣-tocopherol prevented DC maturation. These findings show that human oxidized  2 -GPI, probably by interacting with a member of the Toll-like receptor (TLR) family, causes DCs to mature. Because this key  2 -GPI function requires oxidative modification, in several chronic disorders related to endothelial cell dysfunction oxidative stress might trigger the "autoimmune spiral.
Introduction 2 -glycoprotein I ( 2 -GPI), a human plasma protein that binds to negatively charged phospholipids, is the most common target for antiphospholipid antibodies (aPLs). These autoantibodies are associated with thrombotic events in systemic lupus erythematosus 1 and primary antiphospholipid antibody syndrome 2,3 and are proatherogenic. 4  2 -GPI also activates lipoprotein lipase, 5 lowers the triglyceride level, 6 and binds to oxidized low-density lipoprotein (LDL) 7 and to nonself particles or apoptotic bodies to allow their clearance. [8][9][10] Another property of  2 -GPI is its ability to bind at the monocyte surface, thus promoting tissue factor and thereby increasing the risk of thrombotic events. 11  2 -GPI can also be expressed on the endothelial cell membrane 12 and on macrophages. 13 Among the several candidate  2 -GPI cell receptors, annexin II, megaline, and apolipoprotein E receptor 2Ј (apoER2Ј) are involved in activating endothelial cells and platelets. [14][15][16] Recent findings demonstrate that anti- 2 -GPI antibodies react with their antigen probably in association with a member of the Toll-like receptor (TLR)/interleukin 1 (IL-1) receptor family on the endothelial cell surface and directly induce activation. 17,18 Once bound to endothelial cells,  2 -GPI offers suitable epitopes targeting circulating anti- 2 -GPI antibodies that affect cell functions a...